Comparative real-life assessment of left bundle branch area pacing optimized (LOT) ICD and LOT-CRT therapy patients

Abstract Background Left bundle branch area pacing optimized (LOT) resynchronization therapy is a novel treatment option in standard cardiac resynchronization therapy (CRT) indications. LOT-defibrillator (LOT-ICD) and LOT cardiac resynchronization (LOT-CRT) devices have become important treatment modalities recently. Purpose Perioperative and clinical outcome-related comparative data are scarce in LOT-ICD and LOT-CRT therapy patient groups. Methods A comparative assessment of 30 LOT-ICD and 30 LOT-CRT implanted consecutive patients in standard CRT indications was performed. The decision of specific device implantation was made by implanting physicians' clinical preference. Patients were followed for a mean of 18 months. The primary end-point was a clinical composite of cardiac death (CD) or heart failure hospitalization (HFH). Secondary objective end-points were perioperative QRS width reduction and left ventricular ejection fraction (LVEF) improvement. Results LOT-CRT patients had significantly more advanced heart failure regarding baseline LVEF (29.6±5.2% vs. 31.7±6.7%; p=0.034), NYHA functional status (2.7±0.4 vs. 2.53±0.6; p=0.029) and nt-pro-BNP levels (7865±6549 pg/ml vs. 5068±6917 pg/ml; p=0.032 ) compared to LOT-ICD patient group. Despite baseline differences, the LOT-CRT patient group reached significantly fewer primary end-point events (0 vs. 4 events; Log-Rank: p=0.036). Furthermore; LOT-CRT patients had significantly higher perioperative QRS width reduction ( 39.4±15.8 ms vs. 35±18.5 ms, p=0.034) but no statistically significant difference in LVEF improvement (19±11.4% vs. 18.3±10.4%; p= 0.06) compared to LOT-ICD group. Conclusions In our observational patient cohort LOT-CRT patient group has significantly fewer composite event rates of HFH and CD, despite more advanced baseline HF status compared to LOT-ICD patients.KaplanMeierAEfreesurv. baselinechar.